Adventure Christian Church Food Pantry Form Question Title * 1. Contact Information Name Address City/Town ZIP/Postal Code Email Address Phone Number Question Title * 2. How did you hear about the Adventure Christian Church Food Pantry Church Facebook Post Small Group Church Service Announcement Church Website Friend or Family Question Title * 3. Do you call Adventure Christian Church Your Home Church Yes No Question Title * 4. Do you participate in a small group with Adventure Christian Church? Yes No If yes, which group? Question Title * 5. Have you used the food pantry before? Yes No If yes, how many times? Question Title * 6. Please check all dietary restrictions you have. Gluten Free Dairy Free Soy Free Low Sugar Vegetarian Nut Free Egg Free Other (please specify) Question Title * 7. How many people over the age of 14 are in your household? Question Title * 8. How many people are 14 years or younger in your household? Question Title * 9. Please select one bag for each person over 14 years of age in your household. If you prefer the same bag twice please indicate it in the comments section below. We can not guarantee inventory of the stores. The bag options are examples of what could be included. Bag One: Oatmeal, juice, bread, peanut butter, jelly, banana, apple, ground beef, pasta, pasta sauce, and bagged salad. Bag Two: Eggs, juice, canned fruit, banana, bread, sliced cheese, turkey meat, canned beans and frozen vegetables. Bag Three: Cereal, milk, banana, apple, bread, peanut butter, jelly, chicken, rice, canned beans, canned vegetables. If you prefer a bag multiple times please indicate the amounts here. Question Title * 10. Please select one bag for each person 14 years and under in your household. If you prefer the same bag twice please indicate it in the comments section below. We can not guarantee inventory of the stores. The bag options are examples of what could be included. Bag One: Waffles, banana, apple, carrots, hot dogs, buns, and french fries. Bag Two: Cereal, canned fruit, mac and cheese, chicken nuggets and frozen vegetables. Bag Three: Apple, oranges, pancakes, taquitos, canned vegetables, and potatoes. If you prefer a bag multiple times please indicate the amounts for each bag here. Next